VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise of McLean Village
1515 Chain Bridge Road
Mc lean, VA 22101
(703) 245-9270

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Oct. 6, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS

Technical Assistance:

Documentation was discussed with the provider.

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/6/23 (9:00 AM - 5:30 PM) Number of residents present at the facility at the beginning of the inspection: 49 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. An exit meeting was held. Number of resident records reviewed: 8 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 2 Observations by licensing inspector: Meals, medication administration, activities The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-660-B
Description:	Based on observation and documentation, the facility failed to limit medication storage to an out-of-sight place in the rooms of residents whose UAIs have indicated that the residents are capable of self-administering their medication. Evidence: Medication administration for Resident #1 was observed during the inspection. Salonpas pain relieving patches and Refresh eye drops were observed in Resident #1?s room. Resident #1?s Uniform Assessment Instrument (UAI), dated 4/25/23, states that the resident needs her medication administered by professional nursing staff. Resident #1?s record also contains an Assessment of Serious Cognitive Impairment form, dated 5/1/23, that states that she has a serious cognitive impairment with an inability to recognize danger or protect her own safety and welfare.
Plan of Correction:	1. The Reminiscence Coordinator removed the Salonpas pain relieving patches and Refresh eye drops from Resident #1?s room. 2.The Reminiscence Coordinator or Designee will visit other residents? rooms to look for medications. The Reminiscence Coordinator will remove medications he finds. 3. The Reminiscence Coordinator will educate Resident #1?s spouse on the importance of not bringing medications to the community or leaving them in Resident #1's room. The Reminiscence Coordinator will educate other family members as indicated. 4. The Reminiscence Coordinator will educate his staff to look for medications in residents' rooms and report sightings to him. 5. The Reminiscence Coordinator or Designee will look in residents' rooms for medications three times per week for one month and then weekly for one month.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered in accordance with the physician's or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #1?s morning medication administration was observed, during the inspection. Resident #1?s record contains insulin orders, dated 7/21/23 and 9/20/23, that call for the resident to receive insulin before meals. During the inspection, Resident #1?s insulin was administered after she ate breakfast.
Plan of Correction:	1. Staff will administer Resident #1's insulin as ordered. 2. The Resident Care Director or Designee will identify other residents scheduled to receive insulin prior to meals and audit their Medication Administration Records to ensure insulin has been administered per order. 3. The Resident Care Director or Designee will educate team members who administer medications on the importance of following insulin orders, specifically related to mealtime parameters. The Resident Care Director or Designee will also educate team members who administer medications on where to find these types of instructions in order to follow them. 4. The Resident Care Director or Designee will evaluate the order in which team members administer medications to residents in the community to ensure mealtime insulin orders can be reasonably followed. 5. The Resident Care Director or Designee will monitor insulin administration three times per week for one month and then weekly for one month.